UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts Severe Arterial Haemorrhage Secondary to Extracorporeal Shockwave Lithotripsy - An Under Appreciated Life Threatening Complication? Ming Chun Chan (1) , Melissa Hui Wen Tay (1) , Edmund Chiong (1) (1) National University Hospital Introduction and Objectives: Extracorporeal shockwave lithotripsy (ESWL) is a mainstay in the treatment of nephrolithiasis. Renal hematomas are a known complication, but are largely clinically insignificant and amenable to conservative management. Active arterial haemorrhage is extremely rare, with only isolated cases in the literature. This case report describes the first such reported case in Asia, which required arterial embolization to address an alarming drop in haemoglobin, highlighting possible contributing factors and arterial haemorrhage as an important complication following ESWL. Methods: A single patient treated for a 1.3 cm left renal lower pole stone with 2 sessions of ESWL was followed over a 3 month period. Results: A healthy 44-year-old Chinese male with an asymptomatic incidentally diagnosed 1.3 cm left kidney lower pole stone was treated with 2 sessions of ESWL (3000 shocks at 3.0kV up to 100J). He returned the morning after his second session with left flank pain. Computed tomography (CT) of the abdomen and pelvis showed active extravasation at the left renal lower pole resulting in a large retroperitoneal hematoma extending into the pelvis. Haemoglobin dropped from 15.9 to 11.4 g/dLwithin 12 hours of admission, and he became progressively more drowsy, tachycardic and hypotensive. He was resuscitated with fluids and blood products and underwent angioembolization to the offending lower pole segmental artery with three 120 mm interlocking coils. Subsequent supportive management facilitated subsequent uneventful recovery and discharge. Conclusions: This case adds to the small body of literature on arterial haemorrhage as a complication of ESWL, highlighting the importance of early recognition and treatment. C-10195 VALOUR: Evaluation of a Novel Visual Analogue Uroflowmetry Score (VAUS) to Support Shared Decision-Making for Men with Lower Urinary Tract Symptoms and their Primary Care Physicians Shu Hui Neo (3) , Haidee Ngu (1) , Raj Tiwari (2) , Ngiap Chuan Tan (1) , Henry Sun Sien Ho (3) (1) Bukit Merah Polyclinic, (2) Sengkang General Hospital, (3) Singapore General Hospital Introduction and Objectives: Lower urinary tract symptoms (LUTS) in elderly men are common medical problems but are often underdiagnosed in primary care. Timely identification and quick severity assessment are essential for its optimal management. We postulated that a pictorial tool would facilitate LUTS identification, support decision-making in its management, and aid in right-siting of patient care. Methods: Across-sectional survey was conducted on 320 men aged 50 years and above attending a public primary care clinic for general consultations. LUTS status was assessed using IPSS andQOLscores. 60 men from this group withmoderate-to-severe LUTS (IPSS>/=8 and/or QOL>/=3) then underwent a pilot unblinded, randomized controlled trial. 30 randomly selectedmen had VAUS (intervention) and another 30 men did not. The intervention group used VAUS to discuss their symptoms with their primary care physicians while the control did not. Physicians were blinded to IPSS scores in both groups. The outcome measures were referral rate to the urologists; quality of the SDM process, and rates of AUR based on electronic medical records six months after study enrolment. Results: Mean age was 67 years (50-89). 89% were Chinese, 3.4% were Malay, and 7.2% were of Indian ethnicity. Most patients (90%) had at least primary school education. 32.6% hadmoderate to severe LUTs. Referral rates to specialist care, SDM and rates of ARU were similar between the group receiving VAUS (intervention) and not (control group). Conclusions: LUTs from BPH is prevalent in Singapore. IPSS and VAUS are useful for management of LUTs for these men. C-10197 C-10196 Knowledge and Attitude Towards Urology Among Medical Graduates of the British and the Indian Medical Education Systems: Need for Urology Rotation Sanjay Narayana Murthy (1) , Jay Khastgir (2) (1) Mandya Institute of Medical Sciences, Rajiv Gandhi University of Health and Sciences, (2) Swansea University Introduction and Objectives: The increased need for urological skills especially amongst the geriatric population has not been rightly fulfilled by the immediate caregivers who are in most cases, the foundation doctors or equivalent. With the recognition of this concern globally, this study aimed to assess the view of foundation doctors and newly qualified trainees from two different healthcare systems inmanaging urological emergencies routine inpatient tasks. Methods: Questionnaire based data was collected anonymously from interns across all specialties during the study period of 4 months in 2019 from three universities in the UnitedKingdom(Birmingham, Swansea and Southampton) and one university in India (Rajiv Gandhi University of Health and Sciences). Information included perceived confidence in managing specific urological emergencies and routine inpatient tasks. Results were analyzed using descriptive statistics. Results: In total, 110 and 35 responses were collected from the three UK universities and one Indian university respectively. Of which, 51% and 60% of the trainees in the UKwere not confident managing urology emergencies and undertaking independent decisions in inpatient tasks respectively,in contrast to 45% and 35% in Indian counterpart. Overall, 80% of the trainees felt that they had inadequate clinical exposure to urology and only 3% considered a career in this specialty. Conclusions: Our study highlights the deficit of formal urological training as a direct cause to impeded confidence in managing urology related emergencies and consequent non consideration of urological career across healthcare systems. Thus, inclusion of urology rotation in the undergraduate education is warranted in viewof prudent service provision and patient safety. Designing a Novel Single-Use Urethral Plug for Men with Post Radical Prostatectomy Incontinence YongAi Roxanne Teo (2) , Sharon Eu-Kiang Yeo (2) , Daniel Zhen-Peng Yong (2) , Kun Ming Thian (1) , Arianto Yuwono (2) (1) CHI Living Lab, Centre for Healthcare Innovation , (2) Tan Tock Seng Hospital Introduction and Objectives: About 15% of men who underwent radical prostatectomy have stress urinary incontinence. (1) There are a variety of continence products available in the market, including absorbent pads, urinary sheaths, body worn urinals (BWU) and penile compression clamps (PCCs). PCCs compress the urethra to prevent leak, and are significantlymore secure in preventing leakage compared to other devices. (1, 2) However, they can be uncomfortable and may result in penile trauma with prolonged use. (3, 4) The aim of this study was to design an alternative continence product effective at reducing leakage yet circumvents the problemof penile discomfort and injury with its usage. Methods: We designed an alternative continence product in the form of a urethral plug. A prototype was printed using 3D technology and its efficacy was tested on a model. Results: The product was designed to include a tapering end to be inserted into the distal end of the urethra, with an external component intended to keep the plug secure in its place. The product is designed in 2 different sizes. The plug is placed into the urethra to provide a seal and removed each time urination is necessary. Conclusions: Further studies are required to select suitable materials to be used for these urethral plugs, and to evaluate its comfort and usability before it can be recommended as an effective alternative to PCCs. C-10192 21